Siena College Taytay

CHAPTER II:
College of Nursing
DECISION MAKING IN VALUE ISSUES

 Virtue Ethics: Value Confrontations

As NURSE practitioner, we are educated in the science and art of our specialties. It is
our values that tell us what is right and wrong, good or evil, and that imply a
preference in regard to correct human behavior.
Value choices are subject to very different answers depending upon the value
structure of the practitioner.

 Telelogical (Consequence-Oriented) Theories

Consequence-oriented theories judge the rightness or wrongness of decisions based
upon outcomes or predicted outcomes.
Jeremy Bentham (1748-1832) & John Stuart (1806-1873)-fathers of
utilitarianism believes that “The good resides in the promotion of happiness or the
greatest net increase of pleasure over pain.”
John Stuart Mill defined happiness as set of higher order pleasures such as
intellectual, aesthetic and social enjoyment rather than mere sensual pleasure.
Act Utilitarianism- the decision is based on listing the possible alternatives for
action, weighing each in regard to the amount of pleasure or utility it provides and
selecting the course of action that maximizes pleasure.
Hedonism- One derives pleasure from the pain of others and justifies their actions
on the basis of utility.
Equal consideration of Interest- “One is ought to act as so to produce the
greatest balance of happiness over unhappiness everyone being considered.”

 Criticisms of Utilitarianism (6)

1. The calculation of all the possible consequences of our actions, or worse yet our
inactions, appears impossible.
2. Utilitarianism may be used to sanction unfairness and the violation of rights. In
maximizing the happiness violate the happiness of the other individual or group.
3. Utilitarianism is not sensitive to agent-relativity of duty.
4. Utilitarianism does not seem to give enough respect to persons.
5. It is justifiable to prevent others from doing what we believe to be harmful acts to
them.
6. Utilitarianism does not provide a basis for our own moral attitudes and
presuppositions.

 Utilitarian Responses to Criticisms

Utilitarianism is criticized through the basis that this reasoning appears to allow one to
use the other people as means to an end rather an end to themselves.
Utilitarian’s 3 types of defenses as they respond to their critics:
1. Deny that the critic’s scenario would play out as claimed.
2. Bite the bullet and argue that the supposedly counter-intuitive result should issue in
a revision of our intuitions rather than a change in rejection of the theory.
3. Utilitarians might move to rule utilitarianism.

 Rule Utilitarianism- A formulation of utilitarianism that seems to avoid the problem of

exact quantification required in act utilitarianism.

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E
Publishing Inc.
San Juan Metro Manila. 2nd Edition. Pp.19-37.
 Siena College Taytay
CHAPTER II:
College of Nursing
DECISION MAKING IN VALUE ISSUES

Principle of utility- a rule that has been validated that requires that the rule bring
about positive results when generalized to a wide variety of situations.
Agape or Good- general goodwill or love for humanity

 Fletcher’s six guidelines for making ethical choices: (ComConProgPriAdAc)

1. Compassion for people as human beings
2. Consideration of consequences
3. Proportionate good
4. Priority of actual needs over ideal or potential needs
5. A desire to enlarge choice and reduce chance
6. A courageous acceptance of the need to make decisions and the equally
courageous acceptance of the consequences of our decisions

 Deontological (Duty-Oriented) Theories

Duty-oriented ethics feel that the basic rightness or wrongness of an act depends upon
its intrinsic nature rather than upon the situations of the consequences. The theorists
promotes that the right action is one based on the right principle and that merely
serving good is not an adequate foundation for ethics.

Immanuel Kant (April 22, 1724-February 12, 1804) based his moral philosophy that
human are rational beings and a central feature of this rationality was that principles
derived from reason were universal.
Categorical Imperative (C.I.)
 Criticisms of Kant C-Do not admit exceptions
-Too Rigid for real life situations. I-Command derive from a
-Morality cannot be derived from principle
pure reason. 3 Elements of Imperatives
1. Universal application
-Disregarding the consequences. 2. Unconditionally
of our actions can lead to disastrous results
3. Demanding an action
-Kant’s rule against mistreatment of animals was indefinite as our
duty to animals was indirect.
-Respond’s in two ways: (1) there is often a way of an apparent dilemma (2) we are
obliged to choose the less
egregious violation of our duty to others or on ourselves in times of tragic situation.

 Kantian Responses to Criticisms (5)

To believe that one needs exceptions is to regard experience as central to morality,
which is metaphysically incorrect
Morality is indeed the basis of morality becomes clear if we imagine someone has their
pain receptors impaired resulting to absence of pain.

 Virtue Ethics
 Virtue ethics is an approach that deemphasizes rules, consequences and particular
acts and places the focus on the kind of person who is acting.
Primary focus is the heart of the moral agent making the decision rather than reasoning to
a right action.

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E
Publishing Inc.
San Juan Metro Manila. 2nd Edition. Pp.19-37.
 Siena College Taytay
CHAPTER II:
College of Nursing
DECISION MAKING IN VALUE ISSUES

 Virtue Ethics Responses to Criticism

1. While in the true virtue that virtue does not give specific directions for virtue ethics
is concerned with character, not action.
2. Virtue ethics takes it as good thing that it does not change quickly in response to
the whims of the masses.
3. While virtue ethics does not emphasize the rationality of the individual decision
maker, it does not rely on higher reason: the wisdom of the ages.
 Divine Command Ethics- there is a divine being who has set down a finite series of
rules that adherents claim can provide guidance to most, if not all, moral decisions.
Criticism of Divine Mandate Theory (4)
Divine Command to Criticism (4)

Edge R. and Groves J. R. (1999) Ethics of Health Care: A guide for Clinical Practice. C & E
Publishing Inc.
San Juan Metro Manila. 2nd Edition. Pp.19-37.